=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023837069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIYA C YOSHIDA DO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2024
-----------------------------------------------------
Last Update Date | 10/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 W LA VETA AVE STE 470
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-4305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-737-0986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 W LA VETA AVE STE 470
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-4305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-835-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIYA C YOSHIDA
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 714-706-9308
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------